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General NPI Number Information
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NPI Number | 1609526144
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Entity Type | Individual
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Provider Name | BLAKE AUSTIN MARTIN DDS
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Gender | Male
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Dates
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Enumeration Date | 03/27/2022
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 8310 STATE AVE
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City | KANSAS CITY
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State | KS
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Zip | 66112-1841
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Country | US
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Telephone | 913-334-5225
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Fax |
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Provider Business Mailing Address
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Address Line | 22157 207TH ST
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City | TONGANOXIE
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State | KS
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Zip | 66086-4139
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Country | US
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Telephone | 913-485-9878
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 61913
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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